| NPI | 1407259260 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30522) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: RI DEN03234) |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2014-10-07 |